Personal Information

* First Name:  

* Last Name:  

* Age:  

   Spouse's First Name:  

   Spouse's Last Name:  

   Spouse's Age:  

* Address Line 1:  

   Address Line 2:  

* City:  

* State:  

* Zip Code:  

* Home Phone:  

   Cell Phone:  

* Will you accept a collect call from us?  -Yes   -No

* When is a good time to reach you?  

   Email Address:  

   Your Employer:  

   Work Phone:  

   Spouse's Employer:  

   Spouse's Work Phone:  

* Number of children living in the house:   None One Two Three Four or more

   Ages of the children in the house: 

* Please indicate which best describes your current living situation:   House Condo/Apartment/Townhouse Mobile Home

* Do you own or rent?   Own Rent/Lease Live with parents

   If you rent, name & phone number of land lord:  

* If you own, have you verified with your home owner's insurance agent that adopting a rottweiler will not adversely affect your insurance policy?  -Yes   -No

* What type of environment do you live in?   City Suburban Country

* How long have you lived at this address?   Less than 1 year 1 to 2 years 2 to 4 years over 4 years

* Besides your immediate family, are there others residing in your home?  -Yes   -No

   Names:  

   Ages:  

* Does your home have a yard?  -Yes   -No

   Is it completely fenced in?  -Yes   -No

   What type of fence and how tall?  

   Will gate be locked with a pad-lock?  -Yes   -No

   Is the fence secured underground as well?  -Yes   -No

* Does your home have a pool or spa?  -Yes   -No

   If so, is it fenced?  -Yes   -No

   If so, what type of fencing? (block, wrought iron, etc..)  

   Are you aware that many rottweilers enjoy swimming and if you have an unfenced pool the rottweiler will most likely swim in it?  -Yes   -No

Adoption Information

* Is someone home during the day?  -Yes   -No

   If no, where will the dog stay while you are gone?   Inside Outside Garage/Basement Other (specify)

   If Other?  

* Where will your dog be kept most of the time when you ARE home?   Inside Outside Garage/Basement Other (specify)

   If Other:  

* If kept outside, will you have a dog run/dog house?  -Yes   -No

   (Dogs are not to be chained or tied out and left at any time)

   Indicate for each day the times you will spend with your dog each week:

* Sunday:     

* Monday:     

* Tuesday:    

* Wednesday:  

* Thursday:   

* Friday:     

* Saturday:   

* What activities do you plan to do with your rottweiler? (i.e., camping, hiking, agility, herding, etc.)  

* Do you agree to spay or neuter this dog if it has not been done already? -Yes   -No

* Will you take your dog to obedience class?  -Yes   -No

* Have you ever owned a rottweiler?  -Yes   -No

   If so, where is that rottweiler now?  

* Do you prefer a male or female rottweiler?   No Preference Male Female

* What age range will you accept?  

   If there is a dog on our site that you are interested in, indicate their name:  

* Why do you want a rottweiler rather than another breed?
 

* Will the rottweiler be trained as a guard or watch dog?  -Yes   -No

* What are your favorite qualities in the rottweiler breed?
 

* What are your least favorite qualities in the rottweiler breed?
 

* Do you realize that because of the rottweiler's size and strength, that this breed of dog requires more training and socialization than other breeds?  -Yes   -No

* How will you ensure that the rottweiler you get is well-socialized?
 

* How big would you like your full-grown male rottweiler to get?   No Preference Small (70 to 85 lbs) Normal (85 to 105 lbs) Huge (105 to 130 lbs)

* How big would you like your full-grown female rottweiler to get?   No Preference Small (65 to 80 lbs) Normal (80 to 95 lbs) Huge (95 to 110 lbs)

   If you desire a "huge" sized rottweiler, do you realize that the larger size could affect its health and life expectancy, resulting in higher vet bills?  -Yes   -No

* What do you estimate the monthly expenses to be in owning a rottweiler?  

* How often should a healthy dog go to the vet?  

* How much do you estimate a typical vet bill to be?  

* Are you willing to pay for a heartworm test?  -Yes   -No

* Which brand of dog food will you feed?  

* Why did you choose it?  

* Which of the following methods/tools do you use in training a dog: Choke chain, prong/pinch collar, GL/Halti collar, electric collar, food/toy reward, others (describe)?
 

* Briefly describe the methods you will use to discipline the dog when it misbehaves (for example, if it eliminates on your carpet):
 

* How will you ensure that the rottweiler you get accepts you as the authority figure (for example if it growls at you)?
 

* Have you heard of "clicker" training?  -Yes   -No

* Are you interested in learning other training or discipline methods?  -Yes   -No

* Do you think that rottweilers can be stubborn and hard to manage?  -Yes   -No

* Are you willing to hit a dog that is acting up?  -Yes   -No

* Do you consider yourself a strict or lenient dog owner?   Very strict Somewhat strict Neither strict nor lenient Somewhat lenient Very lenient

* What kind of rottie personality are you looking for?   Energetic and bouncy Active and athletic Relaxed yet playful Kicked back, mellow Total couch potato

* What books on dog behavior/training have you read?
 

* What books on the Rottweiler breed have you read?
 

* How would you rate your knowledge of the Rottweiler breed?   I have never actually met a rottweiler I've met rotties in passing I know people who own/owned a rottie I lived with or dog sat for a friend's rottie for a short time I own/have owned a rottweiler I own/have owned two rottweilers I have owned several rotties or worked directly with them for years as part of my job I have owned or handled rottweilers in the show ring I have stewarded at a rottweiler specialty show and am training to become a judge I am qualified to judge rottweilers at an AKC or USRC dog show

* Did you read our FAQ on the previous page?  -Yes   -No

Other Pet Information

* Do you currently have other pets?  -Yes   -No

   Other pet type:  

   Age(es) of pet(s):  

   Sex(es) of pet(s):  

   Describe its/their personality and interactions with new dogs:
 

   Are your other pets current on all vaccinations?.  -Yes   -No

   Are your animals on heartworm preventative?  -Yes   -No

   If so, what type?  

   Has your current pet received obedience training?  -Yes   -No

   If you currently own a dog or cat or have had one in the last two years, please provide your veterinarian's name and phone number:  

   If applicable, approximate date of your current pet's last vet visit:  

* Have you ever owned other dogs that are no longer with you? If so, what happened to them? (list all dogs you have owned as an adult)
 

* Have you ever had to relinquish a dog?  -Yes   -No

   If so, what were the circumstances?
 

   List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:  

* How did you hear about Phoenix Area Rottweiler Rescue?   Internet Search (specify) Friend Veterinarian Animal Shelter Another Rescue Group

   If by Internet, Veterinarian, Shelter, Rescue or other, please specify which one:  

* We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realize that often the complete history of a rottweiler may not be known and you may encounter some behavioral problems?  -Yes   -No

* Are you willing to work with a behaviorist, if necessary, to correct these problems?  -Yes   -No

   Please provide the name and phone number of three references who can vouch for your ability to care for a pet:

* Name of reference 1:  

* Phone of reference 1:  

   Email of reference 1:   

* Name of reference 2:  

* Phone of reference 2:  

   Email of reference 2:   

* Name of reference 3:  

* Phone of reference 3:  

   Email of reference 3:   

   Additional comments:
 

   I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinary care can be costly and I am able to meet these requirements. Home checks are made on a random basis following adoption. If upon inspection you find that information contained in this application to be false, I understand that you retain the right to turn down the request for adoption or remove the animal from my premises without a refund of moneys paid.

* Signed By:  

* Date of signature:  

Your signed e-mail is a valid legal signature, we do require a hard copy of your signature prior to the final adoption certifying the above information. While we would really appreciate if you submitted this on-line form, you may print the form out and mail it, with your signature to:

Phoenix Area Rottweiler Rescue
P.O. Box 5662
Peoria, AZ 85385-5662

or

info@phxrottrescue.org